Laurie M Dwyer, PHARMACIST

Individual provider Active NPI Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist · Latta, SC

NPI 1962009928 · NPPES record last updated Oct 2, 2020

Key facts

NPI
1962009928
Entity type
Individual (NPI type 1)
Primary specialty
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X
License
7101 (SC)
Practice address
106 E Main St
Latta, SC 29565-1617
Phone
(843) 752-0023
Fax
(843) 752-0079
NPI assigned
Oct 2, 2020
Sex
Female
Sole proprietor
Yes

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
7101SCMDPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Latta Drug Company, Inc. Past
since Oct 4, 2020
Accepting new patients
Latta Drug Company, Inc. Past
since Oct 4, 2020
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Group: 193400000X SINGLE SPECIALTY GROUP
1835P0018X 7101 SC Yes

Addresses

Primary practice location

106 E Main St
Latta, SC 29565-1617

Mailing address

106 E Main St
Latta, SC 29565-1617
Phone (843) 752-0023

Other providers in Latta, SC

All providers in Latta, SC · Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in South Carolina

Sources for this page

Verify at the official NPI Registry.